Claims Questions

What is my group / policy number?

It is the 3 or 4 digit number on your benefits card and booklet.  Sometimes also referred to as a contract  or plan number.

What name do I put down in the ‘Your name’ field, the member or the claimant?

The member’s name should always be filled in at the top of the claim form.

Can anybody fill out my claim form for me?

We strongly suggest that the member fills out and signs each claim themselves.  The member is ultimately responsible for any information on the form.  Filling out your own form limits the possibility of being taken advantage of by fraudulent service providers.

Do I have to fill out the claim details?

Failure to enter the required information on our claim forms could lead to delays in processing your claim.

How long will my claim take to process?

Our claims turnaround time is 1 to 3 business days in-house.  Nearly all claims are reimbursed the day they are received.

I think my cheque was lost in the mail.  Can you reissue the cheque?

We must wait 2 weeks from the issue date before placing a stop payment on the initial cheque at the member’s request.  It has been our experience that delays at the postal office, while rare, can result in cheques taking this long to reach their destination.

Can I fax or email my claim?

We can accept faxed or emailed submissions for dental claims only.  For all medical claims, we require original receipts.

My spouse has benefits coverage as well.  Who do we send our claims to first?

You should always send your own claims to your own primary insurer first, even if you know that the item is not covered.  For children, claims must be sent to the plan of the parent whose birth date comes earliest in the calendar year.  Please note that copies of receipts are acceptable for coordination of benefits.

What does my plan cover?

You may refer to your benefits booklet for plan details.  If you do not have a booklet, speak to your administrator, as they should have a supply on hand.  If you have any questions or require any clarification, please call us and we will be happy to help you.

Where can I get claim forms?

We have claim forms on our download page that you can fill out and print.  You can also get original claim forms from your Human Resources Department.  We also include a claim form when mailing reimbursements to your home.

What is the drug identification number referred to on the Medical and Drug Expenses Claim form?

This field applies only to prescription drugs and can be left blank for all other claims.  Each drug has a drug identification number (DIN) assigned to it that helps us determine the eligibility of the drug.  This number is not to be confused with the Rx number (prescription number) or Tx number (transaction number).

What claim form do I use to submit a vision care claim?

Vision care claims must be submitted with a Medical and Drug Expense Claim form.  We do not use separate claim forms for vision care.

My dental office is telling me that my claim was rejected because I don’t have coverage, why is that?

It is possible that they are sending the claim to the wrong company.  Please have your dental office call us to have this sorted out.

What is the information on the orange strip on the bottom of my card?

This information is for your dentist in order to submit claims electronically. This information is not specific to your group. Our EDI network is NDC Health/ACE, our CDA # is 610146, and we use batch/version 2.

Do I have to use your Dental Expenses Claim form?

A Standard Dental Claim form provided by your dental office is perfectly acceptable.

What is the HCSA section on the claim form?

This refers to Health Care Spending Account plans.  This may or may not be applicable to your plan.  Please refer to your booklet to confirm, or give us a call.

If I elect to pay a portion of my claim through my Health Care Spending Account, will you still pay any amount through the core portion of my plan?

For plans that have both core benefits and Health Care Spending Account, we will always pay first through the core portion.  Only the amounts that we are not able to process through the core portion will be paid through the Health Care Spending Account.

Administration Questions

How do I add a dependent?

In order to add a dependent, you must fill out a Change of Record form and mail or fax it to us.

At what age will my child’s coverage cease?

Most plans allow for coverage of dependent children to at least age 19.  Most plans will cover beyond that for full time students at accredited post-secondary institutes up to age 25 or 26.  Please check your benefits booklet for your specific plan’s details.  We require an updated Overage Dependent form each new school year to confirm eligibility.  Disabled dependent children can be covered indefinitely.

How do I change my address?

This can be done several ways.  You can fill out a Change of Record form which can be found on our download page.  This form can be mailed or faxed in.  You can call and speak to a client service representative.  Lastly, you can enter the address on the claim form when making a claim.  If you elect to do this, you should highlight the fact that it is a new address to ensure that it is not missed.

I have lost my certificate card, can you send me a new one?

Certainly, just give us a call and we will send a new card to your administrator.  If you have lost your travel card, contact your administrator to get a new one.  If they do not have a supply on hand, we may need to order more, so try to do this well in advance of your travel date.

How much do I pay for benefits?

The amount that is deducted from your pay cheque is decided entirely by your employer, so this question should be referred to your Human Resources Department.

Comments are closed.